Editorial: Measuring Obesity: The Need for Simplicity

Abstract

Obesity, traditionally defined by the body mass index (BMI), is now recognized as a chronic, multifactorial disease characterized by excess adiposity that impairs organ function. The 2025 Lancet Commission advocates a function-oriented framework, moving beyond isolated BMI and incorporating measures of fat distribution such as waist circumference (WC) and waist-to-height ratio (WHtR). However, applying global criteria directly to the Indian population presents significant challenges. The prevalent “thin-fat” phenotype among Indians, high visceral adiposity, and insulin resistance at lower BMIs necessitate lower, ethnicity-specific anthropometric cutoffs to accurately predict cardiometabolic risk. Existing global BMI thresholds significantly underestimate obesity prevalence and risk in India, overlooking the metabolically obese normal-weight (MONW) phenotype, which affects 15%–30% of the population. A simplified, primary care-focused classification for India is proposed, combining BMI > 23 WHtR (>0.5) and the presence of complications. This approach aims to enhance early risk stratification and guide interventions, particularly in resource-constrained settings, while acknowledging the need for consensus and validation through large-scale, longitudinal Indian studies to fully optimize diagnostic and prognostic utility.